National Immunisation Schedule of India (UIP) — Vaccines, Doses, Routes, Cold Chain, VVM and AEFI

The Expanded Programme on Immunization began in 1978 and was renamed the Universal Immunization Programme (UIP) in 1985, when it was extended beyond urban areas. It became part of the Child Survival and Safe Motherhood programme in 1992, the Reproductive and Child Health programme in 1997, and has been part of the National (Rural) Health Mission since 2005. It targets about 2.67 crore newborns and 2.9 crore pregnant women every year.

The UIP now protects against 12 diseases: tuberculosis (severe childhood forms), diphtheria, pertussis, tetanus, polio, measles, rubella, hepatitis B, Haemophilus influenzae type b disease, rotavirus diarrhoea and pneumococcal disease nationwide, plus Japanese encephalitis in endemic districts. A child is fully immunised when all vaccines due in the first year of life have been given; complete immunisation adds the vaccines due before 2 years.

• Landmarks: India certified polio-free in 2014; validated for maternal and neonatal tetanus elimination in 2015.
• Mission Indradhanush (December 2014): catch-up campaigns for unvaccinated and under-vaccinated children, aiming for 90% full immunisation coverage.
• Digital systems: eVIN tracks vaccine stock and storage temperature at every cold chain point; U-WIN, launched nationwide in 2024, is the electronic immunisation registry.

• Vitamin A: 1 lakh IU (1 ml) at 9 months; then 2 lakh IU (2 ml) at 16 months and every 6 months until 5 years — 9 doses in all (2nd to 9th doses can be given in biannual rounds with ICDS).
• Pentavalent = DPT + hepatitis B + Hib; it replaced separate DPT and hepatitis B doses in infancy. A child who started on DPT and hepatitis B completes the series with those vaccines.
• MR replaced measles vaccine; if MR-1 is delayed beyond 12 months, keep at least 1 month between the two doses. For JE, keep at least 3 months between doses.

• Diluents: BCG uses sodium chloride diluent, MR uses sterile water and JE uses phosphate buffer — always the diluent supplied by the manufacturer, kept in the ILR at least 24 hours before use.
• Minor illness is not a contraindication: upper respiratory infection does not stop vaccination; moderate or severe acute illness defers it until recovery.
• True contraindications: a serious allergic reaction to an earlier dose or a vaccine component; live vaccines are not given to immunodeficient children.

On the advice of NTAGI, India replaced tetanus toxoid (TT) with Td (tetanus and adult-dose diphtheria) for all age groups, including pregnant women. The reason was diphtheria: most cases were occurring in children aged 5 years and above, mostly unvaccinated, because immunity after the infant DPT series wanes. Td boosts diphtheria immunity as well as giving tetanus protection.

Give Td-2 or the booster before 36 weeks if possible — but give it even after 36 weeks, and give it to a woman in labour who has not been immunised. HPV vaccine entered the programme in February 2026: girls aged 14 years get a single 0.5 ml intramuscular dose of quadrivalent vaccine in the left upper arm, free and with parental consent recorded on U-WIN. See cervical cancer screening for details.

Vaccines lose potency with heat above +8°C, cold below +2°C, and light. The cold chain keeps them at the right temperature from the manufacturer to the child. At the PHC, all vaccines are stored in the ice-lined refrigerator (ILR) at +2°C to +8°C for up to one month; deep freezers (−15°C to −25°C) freeze ice packs. An ILR can keep vaccines safe with as little as 8 hours of electricity in 24 hours.

• Reconstituted BCG, MR and JE contain no preservative and are the most heat- and light-sensitive: use within 4 hours, because of the risk of Staphylococcus aureus contamination and toxic shock syndrome. They come in amber vials. Opened rotavirus vaccine is also used within 4 hours.
• Open vial policy: opened vials of hepatitis B, OPV, DPT, pentavalent, TT and IPV can be used for up to 4 weeks (28 days) if the VVM is usable, the vaccine has not been frozen and it is within expiry.
• Shake test checks suspected freezing of adsorbed vaccines: shake a test vial beside a deliberately frozen control vial; if the test vial settles more slowly, it is usable; if it settles as fast or faster, discard it. The shake test does not apply to IPV.

A VVM is a heat-sensitive label on the vial — a square inside a circle. The inner square darkens gradually and irreversibly with cumulative heat exposure. The vaccine can be used if the inner square is lighter than the outer circle, and must be discarded once the square is the same colour as, or darker than, the circle. VVMs were introduced in the UIP in 1997.

• Four VVM types — VVM 30, 14, 7 and 2: the number is the days a vaccine stays potent at +37°C.
• Combination vaccines: the VVM matches the most heat-sensitive component — for DPT, the pertussis component.
• What a VVM does not show: freezing damage. A frozen pentavalent vial can have a perfect VVM — use the shake test for that.

An adverse event following immunisation (AEFI) is any untoward medical occurrence that follows immunisation and does not necessarily have a causal relationship with the vaccine. The 2015 cause-specific classification has five types:

• Serious AEFI: results in death, hospitalisation, persistent disability, or a cluster (two or more cases in one area).
• Severe but not serious: e.g. seizures, hypotonic hyporesponsive episode, persistent screaming, anaphylaxis, severe local reaction, abscess, intussusception — without death, admission or disability.
• Minor reactions: fever, pain and swelling; paracetamol up to 15 mg/kg every 6–8 hours (maximum four doses in 24 hours).
• Rare reactions to remember: VAPP after OPV (2–4 per million, higher after the first dose); suppurative lymphadenitis after BCG; HHE after pentavalent (1–2 per 1000); intussusception after rotavirus vaccine (1–2 per 100 000); thrombocytopenia after MR (3 per 10 000).
• Anaphylaxis: every session must have adrenaline within expiry in the AEFI kit; ANMs are trained to give intramuscular adrenaline.